Outcomes of Reconstructive Hepaticojejunostomy for Post-Cholecystectomy Bile Duct Injuries | ||||
| Minia Journal of Medical Research | ||||
| Volume 31, Issue 3, July 2020, Page 320-328 PDF (585.05 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/mjmr.2022.220311 | ||||
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| Authors | ||||
| Motassem M. Ali; Amr A. Abd-El-Kader; Mohamed Khalfallah; Mohamed A. Mansour | ||||
| Department of General Surgery, El-Minia Faculty of Medicine | ||||
| Abstract | ||||
| Objectives: Bile duct injury (BDI) remains a potentially devastating complication of cholecystectomy. BDI is associated with significant morbidity, high costs, impaired quality of life, and decreased survival. After major BDI, reconstructive surgery by Hepaticojejunostomy (HJ) is usually indicated The study aimed to analyze and evaluate the presentation, characteristics, related investigation, and outcomes of reconstructive Hepaticojejunostomy in patients with postcholecystectomy bile duct injuries. Patients and methods; This study was done in El-Minia university hospital (minia Hepatobiliary unit), including 26 patients who underwent Hepaticojejunostomy Roux-en-Y for post-cholecystectomy bile duct injury (BDI) between May 2017and May 2020, retrospectively and prospectively. Results: The study included 26 patients suffered from iatrogenic BDIs; 19 patients (73%) underwent OC, and 7patients (27%) underwent LC. Regarding injury type; the Leaking, Obstructing, collection, peritonitis, and vascular injuries were 26.9%, 46.1%, 19.3%, 7.7%, and 4.4% respectively. However, the Strasberg classification of injury was as follow E1 = 15.4%, E2 = 46.1%, E3 = 30.8%, and E4 = 7.7%. In this retrospective study, between may 2017and December 2020, 26 patients with major bile duct injuries sustained during cholecystectomy and requiring surgical treatment in the form of HJ Roux-en-Y were referred to minia hepatobiliary center Preoperatively, US was done for all patients, CT in 3(11.5%), PTC in 3(11.5%), ERCP in 17(65%) and MRCP was done for 16 (61.5%) patients. Conclusion: Early detection of BDI and early referral to specialized hepatobiliary referral centers are essential for early management of BDI and prevention of its complications and any attempt of repair by non-specialized general surgeon should be avoided. Surgical reconstruction using Roux-en-Y Hepaticojejunostomy mucosa to mucosa repair remains the golden standard procedure of choice for treating these injuries with successful outcome and better long-term result. We recommend long-term follow up of the patients after surgical repair for at least 10 years as anastomotic stricture was diagnosed after long peroid. Further studies should be performed for the best management of recurrent anastomotic stricture. Associated vascular injuries should be emphasized and accurately evaluated. | ||||
| Keywords | ||||
| Bile duct injury; cholecystectomy; Hepaticojejunostomy | ||||
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